EXHIBIT “A”
AFFIDAVIT OF GOOD MORAL CHARACTER
STATE OF FLORIDA
COUNTY OF _____________________________
BEFORE ME this day personally appeared ____________________________________________
who, being dully sworn, deposes and says:
I hereby attest that I am of good moral character, that I have not been found guilty of,
regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense prohibited
under any of the following provisions of the Florida Statutes or under any similar statute of another
jurisdiction:
(a)
Section 415.111 relating to adult abuse, neglect, or exploitation of aged persons or
disabled adults.
(b)
Section 782.04 relating to murder.
(c)
Section 782.07 relating to manslaughter.
(d)
Section 782.071 relating to vehicular homicide.
(e)
Section 782.09 relating to killing an unborn child by injury to the mother.
(f)
Section 784.011relating to assault, if the victim of the offense was a minor.
(g)
Section 784.021relating to aggravated assault.
(h)
Section 784.03 relating to battery, if the victim of the offense was a minor.
(i)
Section 784.045 relating to aggravated battery.
(j)
Section 787.01 relating to kidnapping.
(k)
Section 787.02 relating to false imprisonment.
(l)
Section 784.011 relating to sexual battery.
(m)
Chapter 796 relating to prostitution.
(n)
Section 798.02 relating to lewd and lascivious behavior.
(o)
Chapter 800 relating to lewdness and indecent exposure.
(p)
Section 806.01 relating to arson.
(q)
Chapter 813 relating to theft, robbery, and related crimes, if the offense is a felony.
(See 812.014, 812.016, 812.019, 812.081, 812.133, 812.135, 812.14, and 812.16)
(r)
Section 817.563 relating to fraudulent sale of controlled substances, only if the offense
was a felony.
(s)
Section 826.04 relating to incest.
(t)
Section 827.03 relating to aggravated child abuse.
(u)
Section 827.04 relating to child abuse.
(v)
Section 827.05 relating to negligent treatment of children.
(w)
Section 827.071 relating to sexual performance by a child.
(x)
Chapter 847 relating to obscene literature.
(y)
Chapter 893 relating to drug abuse prevention and control, only of the offense was a
felony of if any person involved in the offense was a minor.
I further attest that I have not been judicially determined to have committed abuse or neglect
against a child as defined in s. 39.01(2) and (47), Florida Statutes; nor do I have confirmed report of
abuse, neglect, or exploitation as defined in s. 415.102, or abuse or neglect 415.504, Florida Statutes;
nor have I committed an act which constitutes domestic violence as defined in s. 741.28, Florida
Statutes.
Under the penalties of perjury, I declare that I have read the foregoing, and the facts alleged are
true to the best of my knowledge and belief.
_______________________________________
AFFIANT
OR
EXHIBIT “A”
AFFIDAVIT OF GOOD MORAL CHARACTER
Page 2
To the best of my knowledge and belief, my record may contain one of the foregoing
disqualifying acts or offense.
_____________________________________
AFFIANT